Pharmacy Operations Manager; Remote

Description

Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

We value and invest in our employees to maintain a culture of excellence.

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401(k) match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

Manager-level position responsible for end-to-end operational oversight of pharmacy operations supporting both clinical and non-clinical functions. Accountable for workflow performance, team coordination, and execution across integrated operational models. Leads cross-functional teams responsible for case progression, clinical review support, and completion activities, ensuring alignment with quality, turnaround time, and productivity expectations. Partners with clinical leadership, quality, and operations teams to drive efficiency, reduce rework, and support scalable, high-performing operational workflows.

• Provide operational leadership for pharmacy operations workflows, including both clinical and non-clinical functions supporting IRO services (initial reviews and appeals).
• Own the execution and performance of integrated pharmacy operations, ensuring alignment across case progression, clinical review support, and completion processes.
• Lead cross-functional teams to deliver against key operational metrics, including quality, turnaround time, productivity, and backlog management.
• Drive alignment between clinical and non-clinical workflows to ensure efficient case flow, minimize rework, and optimize resource utilization.
• Partner with clinical leadership, quality, and operations teams to ensure consistency in review practices, documentation standards, and workflow execution.
• Contribute to the ongoing design, refinement, and standardization of operational workflows to support scalability and performance improvement.
• Develop team capability through coaching, performance management, and workforce planning across both clinical and non-clinical staff.
• Identify operational risks, gaps, and inefficiencies, and implement solutions to improve performance and service delivery.

• Lead day-to-day operations of pharmacy workflows, ensuring efficient case progression across clinical and non-clinical functions.
• Own performance outcomes for assigned operations, including quality, turnaround time, productivity, and backlog management.
• Monitor and manage workflow distribution, capacity, and staffing to ensure alignment with volume demands and service level expectations.
• Ensure effective coordination between clinical and non-clinical functions to support seamless case flow and minimize delays or rework.
• Identify and resolve operational bottlenecks, inefficiencies, and breakdowns in workflow execution.
• Establish and maintain performance standards, ensuring accountability at both individual and team levels.
• Provide direct leadership to team members, including coaching, performance management, and development of both clinical and non-clinical staff.
• Partner with quality and clinical leadership to ensure consistency in review practices, documentation, and adherence to internal and external standards.
• Support implementation and stabilization of new workflows, processes, and operational changes to improve efficiency and scalability.
• Analyze operational data and performance trends to identify opportunities for improvement and drive informed decision-making.
• Ensure readiness and operational alignment for new clients, products, or workflow changes impacting pharmacy operations.
• Maintain effective communication with cross-functional partners to ensure alignment on priorities, risks, and performance outcomes.
• Perform other duties as required to support operational performance and business needs.

Skills and Experience:

• Minimum of 2-3 years of supervisory or leadership experience in healthcare operations, managed care, or a related environment.
• Experience supporting clinical review, quality auditing, completion, or similar operational workflows preferred.
• Clinical experience in utilization review, clinical quality auditing, or related healthcare review functions preferred.
• Strong understanding of healthcare operations, including clinical review workflows, case progression, and operational support functions within pharmacy operations.
• Demonstrated leadership experience managing both clinical and/or non-clinical teams in a healthcare or managed care environment.
• Ability to manage end-to-end workflows, including coordination between clinical and non-clinical functions to drive efficient case flow.
• Strong operational and problem-solving skills, with the…